A recent Oklahoman editorial about fines levied by the federal government against hospitals as a result of Medicare rules got the attention of a local podiatrist who was kind enough to write and enlighten us about life as a medical professional today. His observations are worth sharing.
“Very few in the general population understand what is really going on with government health care (Medicare, Medicaid and Obamacare). And what these programs are doing to providers,” he wrote.
Our editorial cited fines handed down against hospitals based on the readmission rate of Medicare patients within 30 days of treatment. In Oklahoma, 53 of 91 hospitals were fined — due to provisions in Obamacare that are designed to reimburse hospitals for the quality of care provided instead of the number of patients treated.
The good doctor said there are two reasons why the public regularly hears stories about “how Mom and Dad can't find a doctor who takes Medicare patients.” One is reimbursement, the other is fear of penalties, audits and even criminal charges.
As to reimbursement, he said general practitioners, internists, endocrinologists and the like — he called them “real docs,” a self-deprecating jab at his own practice — can't make ends meet if they see patients and simply bill for office visits. “If one of these docs sees three patients in an hour at $59 a visit from Medicare, $177 an hour, they can't run a practice on that,” he wrote. “Paying a receptionist, an insurance clerk and a couple of nurses, it doesn't add up. So they either go to work for a hospital and get a salary, or they don't see Medicare patients. ... How does that inequity help senior citizens who need quality health care?”
The other reason many doctors are taking a pass on Medicare — fear of audits, fines, etc. — “is the real problem that has doctors' attention, much more so than poor reimbursements. So much so that more and more docs are ‘opting out' of Medicare. They see senior citizens, patients just have to pay cash. This is the future.”
Meantime the federal government, through Obamacare and other measures, has made doctors far more liable for compliance with Medicare's dizzying regulations and have ratcheted up the possible punishment for noncompliance. Audits can last years, and aren't cheap. Consequently more doctors are choosing not to involve themselves with Medicare.
“The opt-out of Medicare movement with doctors is growing. And it is not going to stop,” our doctor friend wrote.
“If the feds don't start paying docs (the real health care docs) better, and stop with all the draconian punishments for not notating and signing one's charts properly, there is going to be a two-tiered health system,” he predicted. One system will be “for seniors of means who can go to a concierge/VIP practice and bypass Medicare for physician services and keep Medicare for hospitalizations etc.” The second system will comprise “all the others who will struggle to find a doctor, have to wait for appointments, etc., etc.
“Obamacare is forcing this. It is sad. It is sadder that the public is clueless on most of this. They think it is just greedy doctors.”
The future of health care for the one in five Oklahomans who will be 65 or older in coming years? Bleak. If they can manage to find a doctor who treats Medicare recipients, that physician will likely be overwhelmed with patients.